Introduction: Various treatments have been used for post-traumatic tethered cord syndrome (PTTCS) and post-traumatic syringomyelia (PTS), focusing on restoring CSF flow at the injury site. However, the effectiveness of operative versus non-operative approaches is still unclear, and there is no consensus on the ideal surgical method or the impact of presentation on prognosis.
Methods: A comprehensive search was conducted on PubMed, Cochrane, Embase, Scopus, and the Web of Science. We used proportions for single-arm analyses. We evaluated overall improvement in neurological symptoms and syringomyelia. A subanalysis was also conducted based on the type of condition and the surgical technique used.
Results: Our analysis included 30 studies with a total of 971 patients. Among them, 53.6% had PTS alone, while 46.4% had PTS and PTTCS combined. Of these patients, 86.3% were in the operative group and 13.7% were in the non-operative group. Overall neurological symptoms were improved in 61.44% [49.50,72.81] of patients with PTS and in 71.92% [47.96%, 91.47%] of patients with PTS and PTTSC combined. Improvement rates varied by intervention: 67.27% [44.17, 87.27] without shunt, 62.90% [50.22, 74.90] with shunt, 60.22% [50.29, 69.38] without untethering, and 79.33% [47.16, 94.29] with untethering. Similarly, the overall improvement rate for patients with only shunt placement was 55.69% [33.24, 77.18], and for those with shunt plus additional interventions, it was 67.10% [54.67, 78.63]. Overall, 60.52% [51.33%, 69.02%] of patients improved with operation, compared to 28.33%[5.05%, 74.62%] with non-operative management. Additionally, 63.87% [47.53, 77.52] of patients with PTS and 56.14% [14.45, 90.65] of those with both PTS and PTTCS showed improvement in syringomyelia size.
Conclusion : Our analysis suggests surgical intervention resulted in a higher rate of overall neurological improvement compared to non-operative management, with untethering showing the greatest improvement in neurological symptoms. Further robust clinical trials are needed for more conclusive evidence.
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